This drug paradox is making us suffer

‘The current guidelines can make it difficult to access the most effective drugs’

The immune response is a marvel, mobilising the body’s defence network to neutralise and destroy the threat posed by the tens of thousands of different types of viruses, bacteria and other pathogenic organisms. But the immune system can, as we all know, go awry and, rather than combating such external threats, it can turn inwards, directing its firepower on healthy tissue.

Andrew Southworth, in his early 40s and running a successful catering business, had scarcely had a day’s illness in his life until 16 months ago he woke one morning with a widespread, excruciatingly itchy rash, an acutely swollen knee and crippling neck pains, warranting his emergency admission to hospital.

He had, he subsequently learned, joined the unhappy band of those with psoriatic arthropathy, an autoimmune disorder that cruelly combines the two misfortunes of severe psoriasis (described by playwright Dennis Potter as “cracked, scabbed, scarlet and boiling with pain”) and inflammation of the joints, tendons and spine.

He has since set up a support group for those similarly afflicted in his area and a Facebook site for those further afield. In the process, he has encountered the paradoxical anomaly – which applies to other diseases as well – where current guidelines can make it difficult to access the most effective drugs.

Twenty-five years ago, the prospects for those with psoriatic arthropathy and similar autoimmune disorders was transformed by the discovery of a novel compound that targets the key component of the inflammatory response known, rather confusingly, as Tumour Necrosis Factor, or TNF. Given promptly, TNF inhibitors such as infliximab can, rather amazingly, induce a remission in almost two thirds of sufferers, preventing the progressive destruction of the joints that can be a feature of the disease.

They are, however, very expensive (if immensely profitable for the companies that make them). Hence those current guidelines require patients be treated initially with three considerably cheaper but less effective drugs, and only if their crippling symptoms persist do they then qualify for infliximab.

It is a most invidious situation, drawing attention to the further drawback of the current vogue for over-medication where the considerable cost of unnecessary drugs effectively rations the availability of those that can, as here, markedly improve people’s lives for the better.

Exhausting journey

The potentially hazardous tendency to start yawning within half an hour of setting out on a car journey has prompted the suggestion that air-conditioning may be the culprit, by recycling the air within the car thus reducing oxygen levels.

“I find this triggers yawning, as the lungs strive to take in larger volumes of air,” writes one reader. On a similar theme, a woman suggests posture when driving may be responsible, as being slumped in the seat may result in shallow breathing that can also reduce the oxygen levels in the blood.

Alternatively, another reader warns against foods high in carbohydrates (such as pasta or cornflakes) before setting out, as they can have a drowsy, soporific effect. Driven to distraction: could airconditioning trigger yawning?

Back to basics

Finally, a reminder not to overlook long-established, “traditional” remedies, courtesy of a reader with chronic bronchitis caused by occupational exposure to asbestos, coal dust and sulphur fumes from working in power stations all his life. Despite using his inhalers religiously several times a day, he was finding it progressively more difficult to shift the catarrh from his chest and throat when, on impulse, he bought a packet of cherry-flavoured Halls.

He took half a packet the first day and, impressed by how the mentholated cough drops – originally formulated by Thomas Hall in Lancashire in the Thirties – seemed to break up the phlegm in his chest, carried on doing so. His breathing, he reports, is “now greatly improved”, he is coughing less and, to his surprise, his peak flow (the objective measurement of his lung function) has risen from 50 per cent to 71 per cent.